Download When to Titrate

Equianalgesia
RN Certificate in Palliative Care
Equianalgesia
Southern California Cancer Pain
Initiative (SCCPI)
All Equianalgesic charts
are considered
estimates
• Equianalgesic chart
Take age, hepatic and
renal function into
consideration
Equianalgesics
From SCCPI chart
Drug
Parenteral
(mg)
Oral (mg)
Morphine
10 mg
30 mg
Hydromorphone
1.5 mg
7.5 mg
Oxycodone
-------
20 mg
Titration
Titration based on:
• Patient goals
• Break through doses
• Intensity
• Side effects
• Functional capacity
• Sleep
• Emotional state
• QOL
When to Titrate
• IV
What is
the goal?
• Adjuvants
• PO
• Increments of 25-100%
Breakthrough Pain: 3 Types
Spontaneous pain
Incident pain
• No warning, no
• Usually
obvious cause or
predictable and
activity
initiated by
specific activities
End dose failure
• Pain returns tow
the end of the
dosing interval
Opioid Equianalgesic Conversion
Calculation
• Be sure to use your
equianalgesic chart
when doing
conversions. The
SCCPI chart is
recommended.
Step 1
Add the total amount of the current drug in 24 hours
Step 2
Divide the current 24 hour total by equianalgesic value for the current
drug/route
Step 3
Multiply the above number by the equianalgesic value for the new
drug/route = 24 hour dose
Step 4
Determine how many doses will be given/day and divide by 24 hour dose =
amount of medication per dose
Example
• Your patient is on a SQ
7mg/hr. morphine infusion
• 7 mg x 24 hr.=168mg
(parenteral)
• Convert this to long acting
oral morphine
• 168 / 10 (parenteral
conversion)=16.8
• 16.8 X 30 (oral
conversion)= 504 mg in 24
hours
• 504/2 (long acting given
every 12 hours)=252
• Dose at 230 or 260 BID
Calculating Breakthrough Doses:
“Rescue Doses”
• Always ordered with long
acting opioids
• 10-20% of the 24 hour dose
• More than 3 BTP doses in 24
hr. may need to increase
long acting
What Medication is Appropriate for
Breakthrough Pain?
Morphine Short Acting
Calculating Dose
• Either tablets or oral solution
• 504mg was total 24 hour dose and
10-20% of this dose is 50-100 mg
• 15% is 75mg every 1-2 hours PRN
Example
Mrs. Smith is currently taking
sustained release oxycodone
60mg every 12 hours for pain
related to her metastatic
breast cancer. She has taken
4 doses of oxycodone 20mg
in the past 24 hrs. for BTP.
• What should her new dose
of sustained release be?
• New BTP dose?
Daily dose is 120mg + 80mg
BTP=200mg in 24 hours so she
needs 100mg every 12 hours
BTP:
• 10%=20 mg q 1-2 hours
• 15%=30 mg
• 20%=40 mg
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